title: Nicotine-substitute gum-induced milk alkali syndrome: a look at unexpected sources of calcium.
abstract: OBJECTIVE
  This report describes a 64-year-old woman with recurrent hypercalcemia. Her laboratory evaluation was consistent with milk-alkali syndrome. It was eventually discovered that the source of the excessive calcium consumption was nicotine-replacement chewing gum and carbonated water.
  
  
  METHODS
  An extensive literature search was performed to see if milk-alkali syndrome due to nicotine-replacement gum and carbonated water has been previously reported.
  
  
  RESULTS
  No prior report describing the association of milk alkali syndrome with nicotine-replacement gum and carbonated water was found.
  
  
  CONCLUSIONS
  We present a unique case of milk-alkali syndrome due to nicotine-replacement gum and carbonated water. It serves as a lesson to evaluate other sources besides calcium supplements as the cause of excessive calcium intake.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Swanson
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Mackey
authors.forename: Sydney A
authors.initials: SA
authors.lastname: Westphal
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Argueta
mesh_terms: D000279:Administration, Cutaneous; D002118:Calcium / Q000097:blood / Q000378:metabolism*; D061545:Carbonated Water; D002638:Chewing Gum; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D061545:Carbonated Water; D002638:Chewing Gum; D018722:Nicotinic Agonists; D009538:Nicotine; D002118:Calcium